Alternative Approaches for Nausea Control

Earlier research has shown that the effectiveness of acupressure bands in reducing nausea
could be enhanced by boosting patients' expectations of the bands' efficacy. The present
study seeks to confirm and extend these findings in a multi-site, 3-arm, randomized,
controlled study of 216 breast cancer patients beginning chemotherapy who expect to have
nausea. All patients will receive a standardized antiemetic regimen. Arm 1: control; Arm 2:
Expectancy-neutral handout + Expectancy-neutral MP3+ acupressure bands; Arm 3:
Expectancy-enhancing handout + Expectancy-enhancing MP3 + acupressure bands. The
investigators hypothesize that acupressure bands provided with the relaxation MP3 will be
effective in controlling chemotherapy-induced nausea. The two versions of the handout and MP3
are being examined to determine what is the most effective way to deliver the intervention.

Inclusion Criteria:

- Be female.

- Have a diagnosis of breast cancer, any stage.

- Be chemotherapy naïve and about to begin her first course of chemotherapy.

- Be scheduled to receive one of the following four common chemotherapy regimens with
the specified antiemetic regimen. They are:

1. Chemotherapy regimen: Doxorubicin/cyclophosphamide. Antiemetic regimen:
Aprepitant + palonosetron + dexamethasone on Day 1 and aprepitant + dexamethasone
on Days 2 & 3.

2. Chemotherapy regimen: Doxorubicin/cyclophosphamide/docetaxel. Antiemetic regimen:
Aprepitant + palonosetron + dexamethasone on Day 1 and aprepitant + dexamethasone
on Days 2 & 3.

3. Chemotherapy regimen: Docetaxel/carboplatin. Antiemetic regimen: Palonosetron on
Day 1 + dexamethasone on Days 1, 2, & 3.

4. Chemotherapy regimen: Docetaxel/cyclophosphamide. Antiemetic regimen:
Palonosetron on Day 1 + dexamethasone on Days 1, 2, & 3.

Note: Fosaprepitant will be allowed in place of aprepitant, and either granisetron or
ondansetron, on one or more days, will be allowed in place of palonosetron.

- Have a response of > 3 or greater on a question assessing expected nausea as assessed
on a 5-point Likert-scale anchored at one end by 1 = "I am certain I WILL NOT have
this," and at the other end by 5 = "I am certain I WILL have this."

- Be able to read English (since the assessment materials are in printed format).

- Be 18 years of age or older and give written informed consent.

Exclusion Criteria:

- Have clinical evidence of lymphedema, current bowel obstruction, or symptomatic brain
metastases, as determined by their treating oncologist.

- Be receiving concurrent radiotherapy or interferon.